The value of cardiopulmonary ultrasound in etiological judgment and diagnostic timeliness of patients with acute dyspnea
-
摘要: 目的 探讨心肺联合超声在急性呼吸困难病患者病因判断及诊断时效中的价值研究。方法 选取2019年1月—2020年12月期间西安大兴医院急诊科收治的583例突发急性呼吸困难患者。以2019年1月—2019年12月期间(未开展心肺联合超声检查)的279例患者作为对照组(调取以往历史病例资料)，以2020年1月—2020年12月期间(开展心肺联合超声检查)的304例患者作为研究组。研究组所有患者的检查均由同一位高年资超声医生进行心肺联合超声检查，对急性呼吸困难患者进行病因快速判断，后续检查为X线胸片、血气分析、心电图、B型脑钠肽，必要行胸部CT及肺动脉CTA检查等。对照组采用常规心脏超声、胸部X线平片、心电图、血气分析、B型脑钠肽，必要时行胸部CT及肺动脉CTA检查对患者进行病因判断，除超声检查方式不同外，其余检查方法均一致。分析两组病因判断的敏感度并记录诊断时长。结果 研究组304例急性呼吸困难患者中心肺联合超声诊断的病因有左心衰导致的肺水肿、急性呼吸窘迫综合征、气胸、慢性阻塞性肺部疾病(COPD)、肺动脉栓塞、肺炎并胸腔积液与临床确诊病因类型均差异无统计学意义(P>0.05)。研究组患者诊断急性呼吸窘迫综合征、气胸、COPD、肺动脉栓塞的诊断敏感度与对照组相当，差异无统计学意义(P>0.05)；研究组患者对诊断左心衰导致的肺水肿、肺炎并胸腔积液的敏感度显著高于对照组，差异有统计学意义(P< 0.01)；研究组诊断所有急性呼吸困难患者的时长显著短于对照组，差异有统计学意义(P< 0.01)。结论 心肺联合超声可以对急性呼吸困难的病因做出快速准确判断，尤其在左心衰导致的肺水肿、肺炎并胸腔积液的患者中有很高的诊断敏感度，可以显著减少诊断时间，为急诊抢救赢得宝贵时间，值得在急诊救治过程中广泛应用推广。Abstract: Objective To investigate the value of cardiopulmonary ultrasound in etiological judgment and diagnostic timeliness of patients with acute dyspnea.Methods Five hundred and eighty-three patients with sudden acute dyspnea admitted to the emergency department of Xi'an Daxing Hospital from January 2019 to December 2020 were selected to this study (279 in the control group and 304 in the study group). Study group: The etiologic diagnostic methods included cardiopulmonary ultrasound, followed by chest radiography, blood gas, electrocardiogram(ECT), B-type natriuretic peptide(BNP), and chest CT, pulmonary artery CTA when necessary. Control group: Conventional cardiac ultrasound was used to replace the cardiopulmonary ultrasound in the study group, other examination methods were the same. The sensitivity of etiological judgment was analyzed and the diagnostic duration was recorded.Results The etiology of 304 patients with acute dyspnea diagnosed by cardiopulmonary ultrasound included pulmonary edema caused by left heart failure, acute respiratory distress syndrome, pneumothorax, chronic obstructive pulmonary disease, pulmonary embolism, pneumonia with pleural effusion(P>0.05). There was no difference with the type of etiology in clinical diagnosis. The diagnostic sensitivity of acute respiratory distress syndrome, pneumothorax, chronic obstructive pulmonary disease and pulmonary embolism in the study group was similar to that in the control group (P>0.05). The diagnostic sensitivity of pulmonary edema caused by left heart failure, pneumonia with pleural effusion in the study group was significantly higher than that of the control group (P< 0.01). The diagnostic duration of the study group was significantly shorter than that of the control group (P< 0.01).Conclusion Cardiopulmonary ultrasound can make a rapid and accurate diagnosis for the etiology of acute dyspnea, especially in patients with pulmonary edema caused by left heart failure, and pneumonia with pleural effusion. Its high diagnostic sensitivity can significantly reduce the diagnostic duration and win valuable time for emergency rescue. It is worthy of wide application and promotion in the emergency treatment process.
-
Key words:
- cardiopulmonary ultrasound /
- acute dyspnea /
- pulmonary embolism /
- diagnostic timeliness
-
-
表 1 研究组和对照组病因诊断结果比较
例 组别 左心衰导致的肺水肿 肺炎并
胸腔积液急性呼吸
窘迫综合征气胸 慢性阻塞性肺部疾病 肺动脉栓塞 研究组(304例) 超声诊断 167 62 19 15 37 24 临床诊断 167 64 17 14 38 26 对照组(279例) 超声诊断 139 80 29 15 27 19 临床诊断 128 92 32 16 26 20 χ2 13.709 4.545 0.018 0.002 0.061 0.134 P 0.001 0.003 0.894 0.962 0.805 0.714 
下载: 导出CSV
-
[1] Renier W, Winckelmann KH, Verbakel JY, et al. Signs and symptoms in adult patients with acute dyspnea: a systematic review and meta-analysis[J]. Eur J Emerg Med, 2018, 25(1): 3-11. doi: 10.1097/MEJ.0000000000000429
[2] 欧艳, 李芳, 刘利. M-BLUE对于急性呼吸衰竭鉴别及病因诊断中的价值[J]. 临床肺科杂志, 2020, 25(6): 857-861. doi: 10.3969/j.issn.1009-6663.2020.06.012
[3] Pang PS, Collins SP, Gheorghiade M, et al. Acute Dyspnea and Decompensated Heart Failure[J]. Cardiol Clin, 2018, 36(1): 63-72. doi: 10.1016/j.ccl.2017.09.003
[4] Soldati G, Demi M. The use of lung ultrasound images for the differential diagnosis of pulmonary and cardiac interstitial pathology[J]. J Ultrasound, 2017, 20(2): 91-96. doi: 10.1007/s40477-017-0244-7
[5] Staub LJ, Mazzali Biscaro RR, Kaszubowski E, et al. Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis[J]. Emerg Med, 2019, 56(1): 53-69.
[6] Bekgoz B, Kilicaslan I, Bildik F, et al. BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea[J]. Am J Emerg Med, 2019, 37(11): 2020-2027. doi: 10.1016/j.ajem.2019.02.028
[7] Muniz RT, Mesquita ET, Souza Junior CV, et al. Pulmonary Ultrasound in Patients with Heart Failure-Systematic Review[J]. Arq Bras Cardiol, 2018, 110(6): 577-584.
[8] Ferreira AH, Pazin-Filho A. Lung Ultrasound in a Patient With ARDS Secondary to Pancreatitis[J]. Chest, 2020, 158(2): e85-e87. doi: 10.1016/j.chest.2019.09.045
[9] Santos-Silva J, Lichtenstein D, Tuinman PR, et al. The lung point, still a sign specific to pneumothorax[J]. Intensive Care Med, 2019, 45(9): 1327-1328. doi: 10.1007/s00134-019-05677-z
[10] Sartini S, Frizzi J, Borselli M, et al. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study[J]. Intern Emerg Med, 2017, 12(6): 861-869. doi: 10.1007/s11739-016-1498-3
[11] 肖红, 蒲婷婷, 刘宇, 等. 肺部超声和床旁胸部X线检查在诊断老年社区获得性肺炎的对比性研究[J]. 临床急诊杂志, 2012, 13(5): 319-324. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202105006.htm
[12] Zong HF, Guo G, Liu J, et al. Using lung ultrasound to quantitatively evaluate pulmonary water content[J]. Pediatr Pulmonol, 2020, 55(3): 729-739. doi: 10.1002/ppul.24635
[13] 赵晨研, 吴彩军, 刘宇. 肺部超声评估气胸的临床研究进展[J]. 临床急诊杂志, 2019, 20(10): 820-823. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC201910018.htm
[14] Bekgoz B, Kilicaslan I, Bildik F, et al. BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea[J]. Am J Emerg Med, 2019, 37(11): 2020-2027. doi: 10.1016/j.ajem.2019.02.028
[15] Zhu WW, Li YD, Li H, et al. Integrative Cardiopulmonary Ultrasound for Interstitial Lung Disease Assessment: Correlation between Lung Ultrasound Performance and Cardiac Involvement[J]. Ultrasound Med Biol, 2017, 43(4): 744-752. doi: 10.1016/j.ultrasmedbio.2016.11.004
[16] Fei Q, Lin Y, Yuan TM. Lung Ultrasound, a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis[J]. Ultrasound Med Biol, 2021, 47(3): 359-369. doi: 10.1016/j.ultrasmedbio.2020.11.011
[17] Santos-Silva J, Lichtenstein D, Tuinman PR, et al. The lung point, still a sign specific to pneumothorax[J]. Intensive Care Med, 2019, 45(9): 1327-1328. doi: 10.1007/s00134-019-05677-z
[18] Staub LJ, Mazzali Biscaro RR, Kaszubowski E, et al. Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis[J]. J Emerg Med, 2019, 56(1): 53-69. doi: 10.1016/j.jemermed.2018.09.009
-